Provider Demographics
NPI:1659359230
Name:AUGUSTINE, PAUL (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:AUGUSTINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1239
Mailing Address - Country:US
Mailing Address - Phone:248-824-6600
Mailing Address - Fax:248-324-1477
Practice Address - Street 1:7447 CENTRAL BUSINESS PARK DR
Practice Address - Street 2:SUITE 104
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-2831
Practice Address - Country:US
Practice Address - Phone:757-853-1380
Practice Address - Fax:757-282-4550
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101223331207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine